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Prior Authorizations Specialist- Direct Hire

Sacramento, California | Direct Hire Position

Post Date: 06/07/2017 Job ID: 38456.1 Industry: Healthcare/Medical
A healthcare provider in the mid-town area is in need of a prior authorizations specialist to join their team. The Authorizations/Eligibility Clerk will be verifying insurance eligibility for all scheduled patients and will acquire authorizations as needed. The ideal candidate has experience in authorizations, referrals, and scheduling and thrives in a fast paced environment. This is a direct hire opportunity with a growing organization.

Responsibilities: Files requests for prior authorization for all insurances that require based upon plan or insurance contract. Work with insurance to pre-certify/authorize the exam. Requests, obtains, and documentsall prior authorizations (or denials of same) appropriately and in a timely manner. Reviews incoming exam orders and documentation for completeness. Obtains information about patient insurance coverage, benefits and eligibility to ensure timely testing and processing of claims. Establishes strong clinical relationships with referring providers. Maintains and updates internal listing of insurance carriers that require authorization. Runs system generated reports to verify procedures by insurances requiring authorization are being captured. Maintains contact with the referring physician's office regarding status of authorization and any additional documentation or information needed. Assists collection team with obtaining retro authorizations. Coordinates with scheduling, back office, and front office on prior authorization activity. Scans all pertinent referrals and clinical information received in a timely manner.

Requirements: 2+ years' experience working with referrals, scheduling, and authorizations. Working knowledge of managed care, private insurance, Medicare, Medicaid and Worker's Compensation. Knowledge and understanding of CPT and ICD-10-CM coding for authorization documentation. Knowledge ofmedical terminology. Ability to work in a fast paced environment professionally. Excellent communication skills both verbal and written. Experience in establishing relationships with insurance companies and referring practices.Strong written and verbal communication skills. Must be a team player who pays attention to detail.

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